US · guidance
CMS SOM App. H, Tag V503
§ 494.80(a) Standard: Assessment criteria
The patient’s comprehensive assessment must
include, but is not limited to, the following: (2) Evaluation of the appropriateness of the
dialysis prescription,…
Interpretive Guidance §494.80(a)(2)
A hemodialysis (HD) prescription includes the number of treatments per week, length of
treatment time, the dialyzer, specific parameters of the dialysis delivery system (e.g., electrolyte
composition of the dialysate, blood flow rate, dialysate flow rate), anticoagulation, and the
patient’s target weight. An appropriate HD prescription is tailored to meet the individual
patient's dialysis needs. For example, if the patient experiences intradialytic muscular cramping
or a fall in blood pressure, a reevaluation of the related components of the dialysis prescription
(e.g., target weight, ultrafiltration rate (UFR), dialysate sodium level) would be indicated; if a
patient’s laboratory values show an elevated or low potassium, a change in the dialysate
potassium may be indicated.
A peritoneal dialysis (PD) prescription must take into consideration the peritoneal transport rate
(determined by peritoneal equilibration testing [PET]), residual renal function, total body
surface area, certain medical conditions, and, personal preference. The PD prescription
includes the number of exchanges or cycles to be done each day, the volume of fluid to be used
with each exchange, whether fluid is always present in the peritoneal cavity (except for brief
periods between draining and reinfusion of dialysate), and, the concentration of glucose or other
osmotic agent to be used for fluid removal (which may vary according to a prescribed sliding
scale). Use of automated, manual, or a combination of automated/manual techniques should also
be addressed. An appropriate PD prescription meets the patient's dialysis needs. As examples: if
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the patient has difficulty accomplishing 5 exchanges during the day, the IDT should consider
other options, such as overnight treatments using a cycler.
The patient record should demonstrate that the patient’s individual dialysis needs have been
assessed and that the current dialysis prescription has been evaluated to determine whether it is
meeting those needs.
History
Rev.
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
6dca82fdd3d7d34c25db790d44ddb7df0b32202e9e6cb044c5846008a4f6af1d
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